Dispositions Re Euthanasia Among Dutch Physicians: An Interpretation (part 1)
[The first draft of this manuscript was presented in February 1999 to the nursing hospital physicians on staff at Saint Elisabeth Gasthuishof in Leiden, The Netherlands. Variations/revisions of the initial draft have subsequently been presented in numerous academic/professional settings.]
INTRODUCTION
The research upon which this presentation is based began in 1991 as an extension of an ethics project conducted I coordinated with The University of Michigan Department of Obstetrics and Gynecology. We studied end-of-life decision-making from the perspective and experience of 108 gynecologic cancer patients who were receiving care from the department’s gynecologic oncology division. The subject of assisted dying became a central issue in Michigan shortly after the data gathering for this study had been completed. Needing to expand the project to incorporate the subject of assisted dying, I began in Spring 1992 to make what continue to be annual 2-3 week research trips to Holland. The University of Leiden Department for General Practice served as host for the initial visit, has made accessible its faculty as well as its residents, and remains helpful in the coordination of the visits. With each trip, I spend time with a steadily expanding network of Dutch professionals -- including 24 physicians. This research network eventually expanded to include: (1) five general practitioners of varying persuasions regarding euthanasia; (2) a former chair and now emeritus professor with The University of Leiden Department for General Practice who contributed significantly to the formation of a consensus by the early 1980s regarding euthanasia for competent patients experiencing unbearable suffering; (3) a senior neonatologist with the Amsterdam Medical Center who chairs the Dutch Pediatrics Association ethics committee for addressing neonatal decision-making in light of euthanasia guidelines; (4) a senior professor of medical ethics at The University of Leiden who is a past-president of the Voluntary Euthanasia Society; (5) three junior members of the research team at Erasmus University doing follow-up studies to the Remmelink Commission’s 1991 national study of end-of-life decision-making in Holland; (6) a psychiatrist whose assisted-dying case was the first case considered by Holland’s Supreme Court in which the patient’s suffering was not related to a somatic condition.
In this presentation, ‘euthanasia’ refers to action taken by a physician solely or primarily for the purpose of hastening death in response to the persistent request of a competent patient whose suffering is deemed unbearable in spite of all medical interventions. This definition is the definition operative in Holland. In Holland such actions do not include decisions to withhold/withdraw life-sustaining interventions (e.g., ventilator support, surgery, artificial nutrition/hydration, . . .) or decisions regarding the use of medications for the purpose of managing pain symptoms. These limitations on the use of ‘euthanasia’ are consistent with the legal and professional definition used in Holland. In this presentation, ‘euthanasia’ includes ‘assisted suicide’.
I am proposing in this presentation a construct by which to distinguish the range of dispositions toward euthanasia among Dutch physicians. This construct represents an attempt to interpret the views of the network of Dutch physicians whose professional experience it has been my privilege to study longitudinally over the past several years. Four dispositions toward euthanasia among Dutch physicians are differentiated.
INTRODUCTION
The research upon which this presentation is based began in 1991 as an extension of an ethics project conducted I coordinated with The University of Michigan Department of Obstetrics and Gynecology. We studied end-of-life decision-making from the perspective and experience of 108 gynecologic cancer patients who were receiving care from the department’s gynecologic oncology division. The subject of assisted dying became a central issue in Michigan shortly after the data gathering for this study had been completed. Needing to expand the project to incorporate the subject of assisted dying, I began in Spring 1992 to make what continue to be annual 2-3 week research trips to Holland. The University of Leiden Department for General Practice served as host for the initial visit, has made accessible its faculty as well as its residents, and remains helpful in the coordination of the visits. With each trip, I spend time with a steadily expanding network of Dutch professionals -- including 24 physicians. This research network eventually expanded to include: (1) five general practitioners of varying persuasions regarding euthanasia; (2) a former chair and now emeritus professor with The University of Leiden Department for General Practice who contributed significantly to the formation of a consensus by the early 1980s regarding euthanasia for competent patients experiencing unbearable suffering; (3) a senior neonatologist with the Amsterdam Medical Center who chairs the Dutch Pediatrics Association ethics committee for addressing neonatal decision-making in light of euthanasia guidelines; (4) a senior professor of medical ethics at The University of Leiden who is a past-president of the Voluntary Euthanasia Society; (5) three junior members of the research team at Erasmus University doing follow-up studies to the Remmelink Commission’s 1991 national study of end-of-life decision-making in Holland; (6) a psychiatrist whose assisted-dying case was the first case considered by Holland’s Supreme Court in which the patient’s suffering was not related to a somatic condition.
In this presentation, ‘euthanasia’ refers to action taken by a physician solely or primarily for the purpose of hastening death in response to the persistent request of a competent patient whose suffering is deemed unbearable in spite of all medical interventions. This definition is the definition operative in Holland. In Holland such actions do not include decisions to withhold/withdraw life-sustaining interventions (e.g., ventilator support, surgery, artificial nutrition/hydration, . . .) or decisions regarding the use of medications for the purpose of managing pain symptoms. These limitations on the use of ‘euthanasia’ are consistent with the legal and professional definition used in Holland. In this presentation, ‘euthanasia’ includes ‘assisted suicide’.
I am proposing in this presentation a construct by which to distinguish the range of dispositions toward euthanasia among Dutch physicians. This construct represents an attempt to interpret the views of the network of Dutch physicians whose professional experience it has been my privilege to study longitudinally over the past several years. Four dispositions toward euthanasia among Dutch physicians are differentiated.
